title: A theoretical framework for holistic hospital management in the Japanese healthcare context.
abstract: OBJECTIVE
  This paper develops a conceptual framework for performance measurement as a pilot study on holistic hospital management in the Japanese healthcare context.
  
  
  METHODS
  We primarily used two data sources as well as expert statements obtained through interviews: a systematic review of literature and a questionnaire survey to healthcare experts. The systematic survey searched PubMed and PubMed Central, and 24 relevant papers were elicited. The expert questionnaire asked respondents to rate the degree of "usefulness" for each of 66 indicators on a three-point scale.
  
  
  RESULTS
  Applying the theoretical framework, a minimum set of performance indicators was selected for holistic hospital management, which well fit the healthcare context in Japan. This indicator set comprised 35 individual indicators and several factors measured through questionnaire surveys. The indicators were confirmed by expert judgments from viewpoints of face, content and construct validities as well as their usefulness.
  
  
  CONCLUSIONS
  A theoretical framework of performance measurement was established from primary healthcare stakeholders' perspectives. Performance indicators were largely divided into healthcare outcomes and performance shaping factors. Indicators in the former category may be applied for the detection of operational problems, while their latent causes can be effectively addressed by the latter category in terms of process, structure and culture/climate within the organization.
authors.affiliation: Department of Industrial Engineering and Management, Tokyo Institute of Technology, Tokyo 152-8552, Japan. Electronic address: huchenliu@foxmail.com.
authors.forename: Hu-Chen
authors.initials: HC
authors.lastname: Liu
mesh_terms: D019033:Delivery of Health Care, Integrated / Q000379:methods*; D006739:Hospital Administration / Q000379:methods*; D006801:Humans; D007564:Japan; D017146:Models, Organizational; D010865:Pilot Projects; D019984:Quality Indicators, Health Care; D011795:Surveys and Questionnaires
keywords: Holistic management; Hospital management; Performance indicators; Performance measurement; Systematic review